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Association of pain ratings with the prediction of early physical recovery after general and orthopaedic surgery - A quantitative study with repeated measures
Jönköping University, School of Health and Welfare.
Jönköping University, School of Health and Welfare, HHJ. ADULT.
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
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2017 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 11, p. 2664-2675Article in journal (Refereed) Published
Abstract [en]

Aim: To compare different levels of self-rated pain and determine if they predict anticipated early physical recovery in patients undergoing general and orthopaedic surgery.

Background: Previous research has indicated that average self-rated pain reflects patients' ability to recover the same day. However, there is a knowledge gap about the feasibility of using average pain ratings to predict patients' physical recovery for the next day.

Design: Descriptive, quantitative repeated measures.

Methods: General and orthopaedic inpatients (n = 479) completed a questionnaire (October 2012-January 2015) about pain and recovery. Average pain intensity at rest and during activity was based on the Numeric Rating Scale and divided into three levels (0-3, 4-6, 7-10). Three out of five dimensions from the tool "Postoperative Recovery Profile" were used. Because few suffered severe pain, general and orthopaedic patients were analysed together.

Results: Binary logistic regression analysis showed that average pain intensity postoperative day 1 significantly predicted the impact on recovery day 2, except nausea, gastrointestinal function and bladder function when pain at rest and also nausea, appetite changes, and bladder function when pain during activity. High pain ratings (NRS 7-10) demonstrated to be a better predictor for recovery compared with moderate ratings (NRS 4-6), day 2, as it significantly predicted more items in recovery.

Conclusion: Pain intensity reflected general and orthopaedic patients' physical recovery postoperative day 1 and predicted recovery for day 2. By monitoring patients' pain and impact on recovery, patients' need for support becomes visible which is valuable during hospital stays.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017. Vol. 73, no 11, p. 2664-2675
Keywords [en]
Assessment, Nurse-patient interaction, Nurse-patient relationships, Pain, Postoperative care, Quantitative approaches
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-35340DOI: 10.1111/jan.13331ISI: 000418363000018PubMedID: 28475240Scopus ID: 2-s2.0-85020059107OAI: oai:DiVA.org:hj-35340DiVA, id: diva2:1087851
Funder
Medical Research Council of Southeast Sweden (FORSS), 376851Futurum - Academy for Health and Care, Jönköping County Council, Sweden, 598311
Note

Part of doctoral thesis in its submitted form.

Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-01-31Bibliographically approved
In thesis
1. Postoperative pain assessment and impact of pain on early physical recovery, from the patients' perspective
Open this publication in new window or tab >>Postoperative pain assessment and impact of pain on early physical recovery, from the patients' perspective
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Pain is a common postoperative experience. Guidelines recommend performing regular pain assessments, which include self-rated pain and additional communication to capture patients' experiences. During hospitalisation, pain intensity is found to be a vital factor influencing other aspects of an early physical recovery, and is consequently an important item in questionnaires for recovery. These tools consist of extensive questionnaires which are difficult to use in everyday clinical work. A simplified method of monitoring postoperative recovery would benefit both patients and healthcare professionals.

Aim: The overall aim of this thesis was twofold: (A) to determine the ability of extending the use of pain ratings to reflect and predict early physical postoperative recovery and (B) to describe patients’ perspectives on pain assessments.

Methods: The studies were carried out at one (I), three (IV) and four hospitals (II, III) involving general surgical and orthopaedic inpatients. Two quantitative methods were used based on data from questionnaires and medical records. They consisted of one cross-sectional study (I) and one study with repeated measures (IV). An association was sought between pain intensity and postoperative recovery on days 1 and 2 (I, IV), and prehospital data (IV). Two qualitative methods were used involving a phenomenographic (III) approach and Critical Incident Technique (IV), where semi-structured interviews were performed postoperatively and analysed inductively in accordance with the approach.

Results: An association was found between moderate/severe average pain intensity compiled from monitoring records and impact on early physical postoperative recovery on day 1 (I). Retrospective average pain intensity at rest and during activity reflected impact on recovery on postoperative day 1 (IV). Severe pain intensity at rest and during activity on postoperative day 1 predicted impact on physical recovery items on day 2 (IV). The use of the Numeric Rating Scale (NRS 0-10) was considered to facilitate communication about pain, but to involve difficulties of interpretation and place demand on healthcare professionals and care routines (II). Patients’ descriptions of their experiences when in need of describing pain indicated two main areas: patients’ resources when needing to describe pain and ward resources for performing pain assessments (III). Descriptions of their actions when they were in pain indicated two main areas: patients used active strategies when needing to describe pain or patients used passive strategies when needing to describe pain (III).

Conclusions: This thesis contributes to knowledge about the possibility of using patients' self-rated average pain intensity to reflect early physical postoperative recovery on day 1 and to predict recovery on the following day. The pain scale gave patients and healthcare professionals a shared vocabulary, which facilitated communication. Furthermore, dialogue during pain assessments was described as critical in ascertaining whether pain intensity had an impact on different aspects of physical recovery. Environmental factors such as the attitude of healthcare professionals, workload and staffing influenced how pain assessments were performed.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2017. p. 77
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 080
Keywords
pain assessment, pain intensity, pain scale, physichal recovery, postoperative care
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-35346 (URN)978-91-85835-79-9 (ISBN)
Public defence
2017-05-10, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2017-04-20 Created: 2017-04-10 Last updated: 2017-04-12Bibliographically approved

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Eriksson, KerstinWikström, LottaFridlund, BengtBroström, Anders

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